A systematic review 1 including 24 studies with a total of 1 172 subjects (including 5 studies with 340 patients reporting comparative outcomes of surgical and conservative treatment) was abstracted in DARE. The two RCTs reported satisfactory outcomes from surgery in 90%, and from conservative treatment in 91%. Pain (7 studies, 344 patients) was absent or minimal in 93.4% of the surgical group vs 95.6% of the medical group. Range of movement (6 studies with 331 patients) was normal or near normal in 85.7% of the surgical group vs 94.9% of the medical group. Strength (7 studies with 365 patients) was normal or near normal in 86.7% of the surgical group vs 94.9% in the medical group. Radiologically diagnosed posttraumatic arthritis developed in 42% of untreated patients, 43% of nonoperatively treated patients, and 25% of operatively treated patients.
Comment: The quality of evidence is downgraded by sparse data and inconsistency of results (heterogeneity in outcomes for posttraumatic arthritis and other outcomes).
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